MEDICARE: MR. JOHN K GRISWELL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	F3481	TX
2	207P00000X	Emergency Medicine Physician	F3481	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902861610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN K GRISWELL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 32
Second Line	:
City	:	KEENE
State	:	TX
Zip	:	76059-0032
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11801 S. FREEWAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134
Country	:	US
Telephone Number	:	817-790-7780
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	06/21/2010

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Directions to “ MR. JOHN K GRISWELL M.D.” Practice Location

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